Psychiatry & Psychology--General/BPD


QUESTION: I have been diagnosed with borderline personality disorder.  The past two years I have done a lot of hard work with my therapist and she says I am like night and day compared to how I was two yrs ago.  I still struggle with feelings of scared to be left alone..I also have trouble being intimate with my husband.  I was wondering if you could share what you know about BPD or suggestions on something more I could work on.
Right now my therapist is working me up to 1/2 hr breathing each day

ANSWER: Hello...

I am glad to hear your therapist has seen changes in you. You do not say in your post whether you see or feel those changes as well. That would be important to ascertain.

From my experience working with patients that I consider to have Borderline personality characteristics, these patients have been subject to physical, sexual, and most importantly relational trauma. The severity of trauma and the ways that the trauma has been treated by the significant family members determine the severity of the mental illness. Therefore it makes sense that the illness is manifested by disturbances of the intimate relationships of the individual.

Do you feel that the therapy has helped you make significant changes in the relationship you have with yourself and others? Are you able to recognize a shift in the way you feel? If so, then it does seem like you and your therapist are doing well together and I would not want to make any further suggestions because that would be bringing in another perspective that might not be warranted right now.

On the other hand, if you are not seeing or feeling any changes and your husband and you are still struggling with the very same issues of intimacy you were having when you started, then I would suggest you have a talk with your therapist. You might tell her that you are not quite as optimistic about the results of therapy as s/he is. or that you are not feeling the same satisfaction as s/he is. You need to have a frank talk about what the therapy has been doing, how it has helped, and where you feel the therapy has not helped.

Let me tell you that the type of therapy I do, psychoanalytic psychotherapy, does not happen overnight. It takes longer and involves me developing a trusting long-term relationship with a patient. Borderline personality disorder, as I explained, is a result of a severe disruption of early childhood relationship(s). It takes a long time to develop trust and it takes a long time to finally help the patient develop a sense that the patient (you) are lovable, worthy, and an important person in the lives of others.

One thing I am confused about is your statement at the end of your post:

"Right now my therapist is working me up to 1/2 hr breathing each day"

What does that mean? Is the type of therapy she does mainly breathing exercises or is this something new? How will breathing be healing/helpful/supportive for the relational work that is necessary to assist patients with Borderline Personality Disorder to achieve a greater sens of self-in-the-world and be able to tolerate the closeness of others while experiencing the fear of loss? When you spoke of the breathing, you lost me. If you can clarify that piece of it, I might be able to give you some further insight. Thank you for your question.

---------- FOLLOW-UP ----------

QUESTION: From my understanding, she wants me to do meditation so that when I feel anxiety it comes natural..I am thinking that she is doing this to help me with a coping skill when we start psychodynamic therapy.  She says she won't start that kind of therapy until I have my coping skills work automatically for me.
I don't understand that as how can one automatically start meditating without thinking about it.  Surely you would have to choose to do it

I think your therapist knows you best and that you already have built a trusting relationship with her over 2 years. Meditation and mindfulness are two methods which can increase your tolerance of anxiety. Mindfulness also brings in the elements of self-acceptance and non-judgment, which assists in the harsh ways a person can deal with him/herself.

I am wondering if your therapist has spent the last 2 years working with you on breathing practices or if she has engaged in psychodynamic therapy as well? If she is waiting for you to develop some better coping skills, I would be curious how she is assessing when you might be ready for deeper treatment. It seems like you are asking more from her now, so perhaps she has gotten you to the point where you two can begin doing deeper work. It would be very helpful for you to have this conversation with her now.

With regards to meditation, you are right, it is a choice. However, there are ways that frequent meditation and mindfulness can then be more likely to automatically kick in when you begin to sense an anxious state of mind. Perhaps she is getting you to that point. You have been working on this for a while, as I understand it. Do you think you might be able to employ these practices more readily? Is there something else you think you might be needing? Think about these questions and, again, bring them into therapy. It will help deepen the conversation to where the two of you should be heading.

I wish you all the best!

Psychiatry & Psychology--General

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Jacquelynn Cunliffe


I would like to answer under the category of Psychiatry and Psychology. However, I would like to see a separate category for Psychotherapy/Psychoanalysis. I do not answer questions about medications as I do not prescribe. My expertise is in psychotherapeutic treatment.


I am a psychotherapist and psychoanalyst who specializes in the treatment of mental health issues caused by childhood trauma, domestic abuse, eating disorders, relationship difficulties, and a wide variety of psychological disorders. The kind of therapy I do is often referred to as deep therapy, talk therapy, or psychoanalytic therapy. Please note that I am not against medications and when managed well, medication can be an adjunct to psychotherapy intervention. I think it is important for the public to realize that psychodynamic or psychoanalytic psychotherapy DOESmake changes not only in people's minds but those changes can also be detected in their brain structure. Psychotherapy and psychoanalysis are powerful interventions to help people change their lives from the inside out.

American Psychoanalytic Association American Psychiatric Nurse Association Member of Psychoanalytic Center of Philadelphia Member of National Eating Disorder Association

Ph.D.-University of Pennsylvania, Psychology and Education, Division of Human Development M.S.N. and R.N.-B.C. Board Certified Nurse in Psychiatric and Mental Health Nursing. 2-Year Adult Psychotherapy Program graduate 2-Year Child Psychotherapy Graduate Current: Candidate in Psychoanalytic Training at the Psychoanalytic Center of Philadelphia

Past/Present Clients
I have worked with clients who have experienced significant childhood traumas. These patients come with a variety of mental health issues, including anxiety, depression, suicidal ideations, relationship difficulties and diagnoses such as Personality Disorders, Adjustment Disorders, and, though rarely, Dissociative Identity Disorder (formerly multiple Personality Disorder)

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